Network MetaAnalysis of the Efficacy of Individual CognitiveBehavioral Therapy, Family Therapy, and Combined Interventions on Depression and Anxiety: Direct and Indirect Comparisons of Treatment Effects

Background: Depression and anxiety disorders are among the most prevalent mental health conditions globally, with significant personal and societal burden. Individual cognitivebehavioral therapy (CBT), family therapy (FT), and combined interventions represent three major treatment modalities, yet their comparative efficacy through both direct and indirect evidence has not been comprehensively synthesized in a network metaanalytic framework. Methods: A systematic literature search was conducted in PubMed, PsycINFO, Embase, Cochrane Library, and Google Scholar for randomized controlled trials published between ۲۰۲۰ and ۲۰۲۵. A total of ۸۷ studies with ۱۲,۸۴۷ participants were included in a Bayesian network metaanalysis. Effect sizes were calculated as Hedges' (g) with ۹۵% credible intervals (CrI). Surface under the cumulative ranking curve (SUCRA) values were used to rank treatment conditions. Results: All three active treatments were significantly superior to control conditions. Combined interventions (CBT + family therapy) showed the largest effect on depression (g = ۰.۸۹, ۹۵% CrI: ۰.۷۲ to ۱.۰۷) and anxiety (g = ۰.۸۱, ۹۵% CrI: ۰.۶۴ to ۰.۹۸). Individual CBT demonstrated moderatetolarge effects on depression (g = ۰.۷۱, ۹۵% CrI: ۰.۵۸ to ۰.۸۴) and anxiety (g = ۰.۶۷, ۹۵% CrI: ۰.۵۳ to ۰.۸۱). Family therapy showed moderate effects on depression (g = ۰.۵۲, ۹۵% CrI: ۰.۳۸ to ۰.۶۷) and anxiety (g = ۰.۴۸, ۹۵% CrI: ۰.۳۴ to ۰.۶۳). In direct comparisons, combined interventions were significantly more effective than family therapy alone for depression (g = ۰.۳۷, ۹۵% CrI: ۰.۱۸ to ۰.۵۶) and anxiety (g = ۰.۳۳, ۹۵% CrI: ۰.۱۴ to ۰.۵۲), but not significantly different from individual CBT alone. SUCRA rankings placed combined interventions first for both depression (۸۲.۴%) and anxiety (۷۹.۱%), followed by individual CBT (۶۱.۳% and ۵۸.۷%), and family therapy (۳۸.۹% and ۳۵.۲%). Conclusions: Combined interventions integrating CBT with family therapy components yield the highest probability of being the most effective treatment for both depression and anxiety. Individual CBT remains a robust firstline treatment, while family therapy alone, though effective, may be enhanced by combination with CBT techniques.

کلیدواژه ها:

Network metaanalysis ، cognitivebehavioral therapy ، family therapy ، combined intervention ، depression ، anxiety ، treatment efficacy